Provider Demographics
NPI:1801054192
Name:WIENECKE, BENNYE KAYE
Entity type:Individual
Prefix:
First Name:BENNYE
Middle Name:KAYE
Last Name:WIENECKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10330 W 177TH TER
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66062-9597
Mailing Address - Country:US
Mailing Address - Phone:913-681-5568
Mailing Address - Fax:913-681-5568
Practice Address - Street 1:10330 W 177TH TER
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66062-9597
Practice Address - Country:US
Practice Address - Phone:913-681-5568
Practice Address - Fax:913-681-5568
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator